The retired paramedic checks in frequently with Brown, 94, who lives in the same farmhouse in rural Maine where she’s lived since 1940, where she raised sheep and her four children as well as cared for her own mother for the last two decades of her life. The white clapboards have weathered to gray and the barn, the sheep long gone, is beginning to collapse in on itself.

Congestive heart failure and a stroke, plus other consequences of aging, have left Brown housebound and largely confined to a recliner, watching TV to pass the timeor talking by phone with friends or her oldest son, who lives about 100 miles away and has health issues of his own. Brown hasn’t seen her son in more than a year, she said; her other children are dead or estranged. Overlock, who works for a small startup that helps low-incomeseniors stay in their homes, has become the person in her life who monitors her swollen legs for infection.

As he drives toward Brown’s home, on a finger of land bordering Muscongus Bay, Overlock passes houses with logging equipment parked in the driveway or lobster traps stacked outside. Some, like Brown's home, show signs of neglect, and Overlock worries that the people who live in them also might be elderly and isolated.

“They’re out there,” he said, pointing out the windshield toward rolling hills that lead quickly to the bay and the Atlantic Ocean. “If we can find them, help them, keep them safe …”

Overlock is part of a vanguard of health care workers tackling what researchers say is a growing health risk: social isolation. Researchers increasingly are convinced that living alone and losing contact with family and friends can be as much a threat to people's health as more physiological factors, like high blood pressure or obesity.

TOP LEFT: The view from Overlock's windshield as he drives to Brown's home. TOP RIGHT: Snow piled in Brown's yard in front of a collapsing sheep barn. BOTTOM LEFT: Overlock chats with Brown, who is largely confined to a recliner in the former dining room of her farmhouse. BOTTOM RIGHT: Brown keeps necessities within reach, because swollen legs have made it hard for her to stand or walk. | Yoon S. Byun for POLITICO

And the problem is set to get worse in coming decades. Baby boomers, who had fewer children than previous generations, are living longer, often with chronic diseases that can reduce their mobility. Family networks that traditionally cared for older generations are more dispersed or have unraveled altogether. The trend is already acute in rural regions like those in Maine hard hit by the collapse of the paper industry and other manufacturing losses, where young people continue to leave for jobs to the South.

Social isolation is not only unpleasant; it can be deadly. Someone who lacks social relationships has the same risk for early death as someone who is severely obese, according to a2015 analysis by researchers at Brigham Young University. The feeling of loneliness, or a person’s perception of being isolated, has been linked to higher blood pressure and cognitive decline. Taken together, social isolation and loneliness were associated with a 29 percent increased risk for coronary heart disease and a 32 percent increased risk for stroke, according toanother large-scale analysis led by researchers at the University of York in Great Britain.

Just how isolation erodes health is a matter of some speculation. Scientists have long thought that interaction with others is beneficial because of “social control.” Friends and family members prop each other up, encouraging good behavior and healthy habits. When those relationships break down, so can a person’s health.

But in recent years, research has found that something more is at work: Loneliness, often thought of as a matter of the heart, may actually change the brain. The authors of a 2015 paper published in the Annual Review of Psychology theorize that chronic loneliness increases activity in a network of glands that control stress responses and create an inflammatory effect that raises the risk for chronic illnesses.

The reason for this may be a product of evolution. Loneliness may be meant to motivate us, when a spouse dies or when we move to a new city, to seek out new connections that can sustain us physically and emotionally. But when a person can’t act on the feeling in a way that resolves it, loneliness can make people more sensitive to threats and less likely to seek out meaningful relationships for fear of negative consequences.

“We aren’t, by our evolution, designed to be solitary survivors,” said Louise Hawkley, who studies social relationships at NORC, an independent research organization at the University of Chicago. “We need to have others around us.”

WHEN SANDRA LANE, 79, was growing up in Bristol, Maine, where the local newspaper regularly printed the names of people in the hospital so friends and neighbors could call, an elderly aunt lived next door. Afraid of thunderstorms, the aunt would pull on rubber boots and run to Lane’s family home to wait out each squall.

Lane now lives with her husband, Russell, 85, a former lighthouse keeper and lobsterman disabled by post-traumatic stress disorder and depression, in a home they built down a rutted gravel road on a remote pond. More homes have been built nearby in the years since, but most are seasonal. When a blizzard comes during the quiet winter months, Lane said, she feels so isolated “I almost go crazy.”

The Lanes, whose son moved back to Maine from Pennsylvania to help care for them, are working with Overlock through Access Health, a nonprofit launched this year by their longtime doctor, Allan “Chip” Teel, who regularly performed house calls before he closed his practice. Now Teel is working with a local hospital group to pair video calls from a doctor with home visits and phone calls from people like Overlock, who not only checks on medical issues but listens to his patients’ stories, takes out their trash, or couriers a broken hearing aid across the state for a speedy repair. When he called recently and learned Russell Lane was having hallucinations, he took quick action to get Teel on the phone to adjust his medication. The aim of Access Health is to restore some of the attention that a “country doctor” once provided, Overlock said, as well as provide a small sense of community.

LEFT: Elizabeth Brown, shown in a family photo taken around 2001. RIGHT: A camera inside the home of Sandra and Russell Lane, one of several installed by their son, to help him keep an eye on his parents. | Yoon S. Byun for POLITICO

Nearly half of Mainers 65 and older — about 46 percent — live alone, slightly higher than the national rate, according to 2015 U.S. Census data; fewer than one-third lived alone in 1990. Older adults who are lonely are less likely to be married and more likely to have annual household income of $25,000 or less, according toa report conducted for the AARP Foundation by Hawkley and others at NORC using 2010 data. Experts say shifts in family dynamics have compounded other factors that are part of rural life that contribute to isolation, including poor public transportation and long travel times to grocery stores, doctors, community centers or even neighbors’ homes.

It used to be that grandparents “moved into the spare room, and they were there until they left — until they died, I’ll be blunt — and that was part of life’s lesson,” Overlock said. “In today’s society, we all are busy. We all have careers, and we move around.’’ Access Health, he said, is taking “a step to be a surrogate.”

The reach of Access Health, which will cost about $99 a month per patient when the program is fully rolled out, is relatively small. Overlock serves 12 patients now, though Teel hopes each of the program’s health advocates eventually will serve up to 100 people. The need is great.

That’s apparent in the hospital emergency department in Augusta, the state capital, where Rob Boudewijn works as a physician’s assistant. About once or twice a week, he admits a patient who has no acute diagnosis but who lacks the support at home to manage ongoing chronic conditions, such as lung disease and obesity, or simple frailty. “Social admissions,” a frowned-upon reality in many hospitals, allow social workers time to contact family members or to enroll a patient in support services. Sometimes, Boudewijn said, a patient will come to the emergency department showing signs of dementia. Then they spend time with nurses and doctors, just connecting with other people, and their whole disposition changes.

The view from Overlock's vehicle as he drives through rural Maine, worrying about residents isolated in their homes. | Yoon S. Byun for POLITICO

In those patients, he said, he can see the harmful effects of social isolation. "Everybody likes to feel worthwhile."

OXFORD COUNTY, A paper-making region stretching along much of Maine’s border with New Hampshire, was named the state’s least healthy county by a Robert Wood Johnson Foundation analysis in 2010. That prompted a broad group of public health organizations and community groups to undertake a years-long assessment, looking at the root causes of the county’s poor health. They eventually settled not on access to healthy food or exercise or even poverty but on something deeper: disconnection, a feeling of being undervalued, and social isolation.

“Everything we have done since then has been with an eye toward … reducing that root cause,” said Jim Douglas, director of Healthy Oxford Hills, a public health program of the local hospital that facilitated the process.

But what to do about it? While research has made progress in identifying the problem, solutions remain few and far between.

Some studies have found that targeted psychotherapy can help people cope with loneliness in older age. That is unlikely to be a widely adopted strategy in rural communities with limited resources. In the meantime, countless social service agencies are working, much like Overlock, to address the needs of isolated individuals by providing in-home support, meal delivery, transportation or group activities. However, many lack the resources for rigorous research necessary to persuade policymakers to invest in their work.

Oxford has come up with a few local initiatives. A plan to expand community gardens became a means of teaching young people leadership skills. A group concerned about the opioid crisis organized a “recovery rally” in one town and put together a how-to to help other towns do the same. Others organized community conversations about broadband internet access to improve lobbying for its expansion, an important step for job growth and the use of telemedicine.

“It’s a very long-term strategy,” Douglas said. “This is not something we’re expecting to be able to point to in two, three, even seven years and say, ‘This happened because of that.’ It’s really a long-term investment in the county-wide community.”

Julianne Holt-Lunstad, a health psychologist at Brigham Young University and lead author on the 2015 mortality analysis, said reducing social isolation on a national level likely will require something bigger, a societal change prompted by something like the public health campaigns that altered public perception of tobacco use and dramatically reduced smoking rates over the past four decades.

A few efforts are getting underway. In December, the AARP Foundation launchedConnect2Affect.org, a website aimed at raising awareness of social isolation as a major determinant of health. It includes links to research and a searchable database of local and national resources. President Lisa Marsh Ryerson said she hopes it will help inspire more communities to take a broad-based look at how to improve health generally while putting isolation front and center.

Brown holds the remote that operates her television, which she watches to pass the time as she remains largely confined to a chair in her dining room. | Yoon S. Byun for POLITICO

“The reality is that social isolation cuts across the lifespan,” she said.

John Gale, a researcher at the University of Southern Maine’s Muskie School of Public Service who grew up working on his grandparents’ Maine farm and is a national expert on behavioral health in rural communities, said the answer lies in finding new ways to rebuild the community fabric lost over the years. Such efforts, he said, don’t need scientific proof.

“The fact that someone is living out on a farm in the middle of nowhere, can’t get enough food … that seems to be a problem in and of itself,” Gale said. “We all fall into the trap of wanting an evidence base, but sometimes, at the end of the day, [it’s about] doing the right thing. We have to get started.”

Which is where people like Overlock come in. During his visit, Brown reminisced about the days when televisions first arrived in town and she served as a member of the Friendship Women’s Ambulance Corps. As she sat in her recliner in what used to be the dining room, where she spends her days and nights, Overlock checked on her legs, swollen enough that she could be admitted to the hospital. But she won’t go.

“This is my life,” she said, sweeping her arms across her lap and over side tables overflowing with newspapers and letters, cans of food for her white-pawed Miss Alley Cat, and a television remote. “This room is my life.”

Chelsea Conaboy is features editor at the Portland Press Herald in Maine and a freelance writer focused on health care.